Individual
MALISSA J KNOBLOCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4 YOUNT DR STE 2, BLOOMINGTON, IL 61704-3737
(309) 660-6721
Mailing address
4 YOUNT DR STE 2, BLOOMINGTON, IL 61704-3737
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
227017720
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
227017720
MEDICAL MASSAGE
IL
Enumeration date
06/12/2020
Last updated
06/12/2020
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